Patient Care Plans Research Articles

Evaluation of a Plastic and Reconstructive Surgery Resident Non-surgical Cosmetic Clinic Experience

IntroductionAn important component of plastic surgery residency training is independent cosmetic patient management. A resident cosmetic clinic was created at Oregon Health & Science University in 2007 to expand this experience. The cosmetic clinic has traditionally been most successful in offering nonsurgical facial rejuvenation with neuromodulators and soft tissue fillers. This study focuses on the demographics of the patient population and the treatments provided over a 5-year period and compares this experience to those of the same program's attending cosmetic clinics. MethodsA retrospective chart review of all patients seen at Oregon Health & Science University's Plastic and Reconstructive Surgery Resident Cosmetic Clinic between January 1, 2017, and December 31, 2021 was performed. Patient demographics, type of injectable received (neuromodulator versus soft tissue filler), location of injection, and additional cosmetic procedures were evaluated. ResultsTwo hundred patients met the study criteria, which included 114 seen in the resident clinic (RC), 31 seen in attending clinic (AC), and 55 patients seen in both. A primary analysis compared the two groups seen in the resident and attending only clinics. The average age of patients seen in the RC was younger, 45 versus 51.5 (P ≤ 0.05). There was a trend toward more patients in the RC being involved in healthcare as compared to those patients seen in the AC, but this difference was not found to be statistically significant. The median number of neuromodulator visits in the RC was 2 (1, 4) versus 1 (1, 2) in the AC (P ≤ 0.05) The most common location for neuromodulator injections in both clinics was the corrugators. ConclusionsPatients in the resident cosmetic clinic were younger females, most receiving neuromodulator injections. No statistically significant differences were identified in patient population, injections received, and location of injections between the two clinics, indicating a similar trainee skill set and patient care plan between the two clinics.

Effect of Supine versus Sitting Position on Post-Dural Puncture Headache among Patients Receiving Spinal Anesthesia

One of the most commonly reported complications associated with spinal anesthesia is post-dural puncture headache, even while, the precise mechanisms causing post-dural puncture headache are still not well known, which if left untreated, can lead to severe complications such as subdural hematoma and convulsions. The aim of the current study was to evaluate the effect of supine versus sitting position on post-dural puncture headache among patients receiving spinal anesthesia. Design: A quasi-experimental research design Sitting: The present study was carried out at the Menoufia University Hospital's urology and orthopedic surgery departments, Menoufia Governorate, Egypt. Subjects: A purposive sample of 100 adult patients with spinal anesthesia who volunteered to participate in the study and met the inclusion criteria were randomly divided evenly into two study groups. Tools: For data gathering, three instruments were utilized in this study are: 1.Patients' characteristics questionnaire was used to analyze their sociodemographic features, as well as their past, present, and family medical history 2. Visual Numerical Analogue Scale (VAS) was adopted for headache Severity evaluation 3.Headache Impact Index had been adopted to grade severity of post-dural puncture headache's associated complications. Results: There were a statistically significant decrease in post-dural puncture headache's incidence, severity and associated complications among supine position group (study group I) subjects than among sitting position group (study group II) subjects with statistically significant differences existed between the two studied groups. Conclusion: Maintaining patients in supine position for the first 72 hours post spinal anesthesia as a management technique significantly improved their post-dural puncture headache's incidence, severity and associated complications. Recommendations: Designing a plan of care for post-spinal anesthesia patients should include positioning as a simple management technique that could lead to preferable effects regarding their post-dural puncture headache's incidence, severity and associated complications. Replication of the current study on a larger sample size and for longer follow-up period to allow for results' generalization

Developing integrated care pathways for atopic dermatitis-Challenges and unmet needs.

GA2 LEN-ADCARE is a branch of the largest multidisciplinary network of research centres and clinical care in allergy and asthma, GA2 LEN, focussing on the field of atopic dermatitis (AD). AD is a chronic inflammatory skin disease with high burden and many comorbidities requiring different levels of treatment. The need for aligned information from all involved healthcare providers led to the discussion of an integrated care pathway (ICP) plan for AD patient care involving all stakeholders and considering the complexity and variability of the disease, with a particular focus placed on the large number of patients with milder forms of AD. The GA2 LEN ADCARE network and all stakeholders, abbreviated the AD-ICPs working group, were involved in the discussion and preparation of the AD-ICPs during a series of subgroup workshops and meetings in years 2020 and 2021. Here we discuss the unmet needs in AD, the methodology for devising an AD-ICP and the ICP action plan. The GA2 LEN ADCARE network has outlined the unmet needs in AD and provided an action plan for devising AD-ICPs, considering the complexity and variability of the disease.

Improving Compliance With Institutional Performance on Train of Four Monitoring.

We performed a multistep quality improvement project related to neuromuscular blockade and monitoring to evaluate the effectiveness of a comprehensive quality improvement program based upon the Multi-institutional Perioperative Outcomes Group (MPOG) Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) metrics targeted specifically at improving train of four (TOF) monitoring rates. We adapted the plan-do-study-act (PDSA) framework and implemented 2 PDSA cycles between January 2021 and December 2021. PDSA Cycle 1 (Phase I) and PDSA Cycle 2 (Phase II) included a multipart program consisting of (1) a departmental survey assessing attitudes toward intended results, outcomes, and barriers for TOF monitoring, (2) personalized MPOG ASPIRE quality performance reports displaying provider performance, (3) a dashboard access to help providers complete a case-by-case review, and (4) a web-based app spaced education module concerning TOF monitoring and residual neuromuscular blockade. Our primary outcome was to identify the facilitators and barriers to implementation of our intervention aimed at increasing TOF monitoring. In Phase I, 25 anesthesia providers participated in the preintervention and postintervention needs assessment survey and received personalized quality metric reports. In Phase II, 222 providers participated in the preintervention needs assessment survey and 201 participated in the postintervention survey. Thematic analysis of Phase I survey data aimed at identifying the facilitators and barriers to implementation of a program aimed at increasing TOF monitoring revealed the following: intended results were centered on quality of patient care, barriers to implementation largely encompassed issues with technology/equipment and the increased burden placed on providers, and important outcomes were focused on patient outcomes and improving provider knowledge. Results of Phase II survey data was similar to that of Phase I. Notably in Phase II a few additional barriers to implementation were mentioned including a fear of loss of individualization due to standardization of patient care plan, differences between the attending overseeing the case and the in-room provider who is making decisions/completing documentation, and the frequency of intraoperative handovers. Compared to preintervention, postintervention compliance with TOF monitoring increased from 42% to 70% (28% absolute difference across N = 10 169 cases; P < .001). Implementation of a structured quality improvement program using a novel educational intervention showed improvements in process metrics regarding neuromuscular monitoring, while giving us a better understanding of how best to implement improvements in this metric at this magnitude.

Canadian family medicine residency program survey of physical activity curriculum content

Background: Physical activity (PA) is an important contributor to the health of Canadians. However, the extent that PA is included in family medicine residents' education is largely unknown. This study surveyed curriculum experts in Canadian family medicine residency programs to understand what residents learn about PA and to what extent this varies across programs. Methods: Seventeen family medicine residency program websites were reviewed for information pertaining to their PA curriculum. Additionally, curriculum experts were asked to complete a survey to better understand the extent that PA curriculum is included in their programs. Results: Most (82.4%) of the eligible programs responded to the survey; of which, the majority (92.9%) indicated that residents learn that physical inactivity is a risk factor for chronic conditions, to incorporate into patient care plans, and to recommended PA as prevention for chronic diseases. However, half (50.0%) of the programs stated that they believe residents will be sufficiently prepared to incorporate PA in the care they provide patients, less than half (42.9%) teach PA guidelines, and few (21.4%) teach about PA referral to an allied health care provider or community program. Conclusions: The instruction about PA that family physicians receive in Canadian residency programs varied depending on the program. A standard to ensure residents are sufficiently and competently prepared to recommend and advise physical activity as treatment and prevention is needed. Additional studies are needed to understand the opinions and teachings of preceptors who may have an influence over the residency training of Canadian family physicians.

Quality Improvement Initiative Implementation at the Unit or Hospital Level.

Quality improvement efforts take considerable commitment, including mentorship, training, and resources. Leveraging an established framework, such as that outlined by the American College of Surgeons, to design, implement, and analyze quality improvement projects offers the best chance for success. Herein, we illustrate the application of this framework to a gap in advance care planning for surgical patients. This article helps outline how to go from identifying and outlining a problem, to articulating a clearly defined project goal that is specific, measurable, attainable, relevant, and timebound, and later implementing and analyzing a gap in quality identified at the unit (e.g., service line, inpatient unit, clinic) or hospital level.

Diabetes and cognitive function: An evidence-based current perspective.

Several epidemiological studies have clearly identified diabetes mellitus (DM) as a major risk factor for cognitive dysfunction, and it is going to be a major public health issue in the coming years because of the alarming rise in diabetes prevalence across the world. Brain and neural tissues predominantly depend on glucose as energy substrate and hence, any alterations in carbohydrate meta-bolism can directly impact on cerebral functional output including cognition, executive capacity, and memory. DM affects neuronal function and mental capacity in several ways, some of which include hypoperfusion of the brain tissues from cerebrovascular disease, diabetes-related alterations of glucose transporters causing abnormalities in neuronal glucose uptake and metabolism, local hyper- and hypometabolism of brain areas from insulin resistance, and recurrent hypoglycemic episodes inherent to pharmacotherapy of diabetes resulting in neuronal damage. Cognitive decline can further worsen diabetes care as DM is a disease largely self-managed by patients. Therefore, it is crucial to understand the pathobiology of cognitive dysfunction in relation to DM and its management for optimal long-term care plan for patients. A thorough appraisal of normal metabolic characteristics of the brain, how alterations in neural metabolism affects cognition, the diagnostic algorithm for patients with diabetes and dementia, and the management and prognosis of patients when they have this dangerous combination of illnesses is imperative in this context. This evidence-based narrative with the back-up of latest clinical trial reviews elaborates the current understanding on diabetes and cognitive function to empower physicians to manage their patients in day-to-day clinical practice.

Risk factor identification and prediction models for prolonged length of stay in hospital after acute ischemic stroke using artificial neural networks.

Accurate estimation of prolonged length of hospital stay after acute ischemic stroke provides crucial information on medical expenditure and subsequent disposition. This study used artificial neural networks to identify risk factors and build prediction models for a prolonged length of stay based on parameters at the time of hospitalization. We retrieved the medical records of patients who received acute ischemic stroke diagnoses and were treated at a stroke center between January 2016 and June 2020, and a retrospective analysis of these data was performed. Prolonged length of stay was defined as a hospital stay longer than the median number of days. We applied artificial neural networks to derive prediction models using parameters associated with the length of stay that was collected at admission, and a sensitivity analysis was performed to assess the effect of each predictor. We applied 5-fold cross-validation and used the validation set to evaluate the classification performance of the artificial neural network models. Overall, 2,240 patients were enrolled in this study. The median length of hospital stay was 9 days. A total of 1,101 patients (49.2%) had a prolonged hospital stay. A prolonged length of stay is associated with worse neurological outcomes at discharge. Univariate analysis identified 14 baseline parameters associated with prolonged length of stay, and with these parameters as input, the artificial neural network model achieved training and validation areas under the curve of 0.808 and 0.788, respectively. The mean accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of prediction models were 74.5, 74.9, 74.2, 75.2, and 73.9%, respectively. The key factors associated with prolonged length of stay were National Institutes of Health Stroke Scale scores at admission, atrial fibrillation, receiving thrombolytic therapy, history of hypertension, diabetes, and previous stroke. The artificial neural network model achieved adequate discriminative power for predicting prolonged length of stay after acute ischemic stroke and identified crucial factors associated with a prolonged hospital stay. The proposed model can assist in clinically assessing the risk of prolonged hospitalization, informing decision-making, and developing individualized medical care plans for patients with acute ischemic stroke.

A Comparative Study to Assess the Knowledge Regarding Physical Examination Between B.Sc Nursing and GNM Nursing Students in Selected Academy for Nursing Science, Mysore

Assessment is a key component of nursing practice required for planning and provision of patient and family centered care. Failure in identifying the challenges and problems that students encountered during physical assessment both in classroom and clinical learning environment prevents them from providing patients quality care. During the physical assessment period nursing students are given an opportunity to develop a rapport with patient and their family members which make all nursing procedures easy. Objectives: 1. To assess the knowledge of BSC and GNM nursing students regarding physical examination 2.To compare the knowledge of BSC and GNM nursing students regarding physical examination.3.To find out the association between the knowledge of BSC and GNM nursing students regarding physical examination with selected demographic variables. Methodology: A comparative survey design was adopted for the study. Samples were selected using non probability convenient sampling technique; samples consist of 160 nursing students, out of which 80 from BSC and 80 from GNM. Data collected from the participants by structured knowledge questionnaires on physical examination. Collected data was analyzed by using descriptive and inferential statistics. Result: findings of the study revealed that majority 75% of BSC students and 61.3% of GNM students had moderately adequate knowledge regarding physical examination. The total difference in the mean knowledge score was 0.56 with the t value of 1.02 and found to be not significant at the level of p&gt;0.05. Hence it indicated that there was no significant difference in the knowledge level of BSC and GNM nursing students. Study also reveals that there was a significant association between the knowledge score of the BSC nursing students with demographic variable religion at the probability level of p&lt;0.05.

A Machine Learning-Based Online Prediction Tool for Predicting Short-Term Postoperative Outcomes Following Spinal Tumor Resections.

Background: Preoperative prediction of short-term postoperative outcomes in spinal tumor patients can lead to more precise patient care plans that reduce the likelihood of negative outcomes. With this study, we aimed to develop machine learning algorithms for predicting short-term postoperative outcomes and implement these models in an open-source web application. Methods: Patients who underwent surgical resection of spinal tumors were identified using the American College of Surgeons, National Surgical Quality Improvement Program. Three outcomes were predicted: prolonged length of stay (LOS), nonhome discharges, and major complications. Four machine learning algorithms were developed and integrated into an open access web application to predict these outcomes. Results: A total of 3073 patients that underwent spinal tumor resection were included in the analysis. The most accurately predicted outcomes in terms of the area under the receiver operating characteristic curve (AUROC) was the prolonged LOS with a mean AUROC of 0.745 The most accurately predicting algorithm in terms of AUROC was random forest, with a mean AUROC of 0.743. An open access web application was developed for getting predictions for individual patients based on their characteristics and this web application can be accessed here: huggingface.co/spaces/MSHS-Neurosurgery-Research/NSQIP-ST. Conclusion: Machine learning approaches carry significant potential for the purpose of predicting postoperative outcomes following spinal tumor resections. Development of predictive models as clinically useful decision-making tools may considerably enhance risk assessment and prognosis as the amount of data in spinal tumor surgery continues to rise.

By integrating single-cell RNA-seq and bulk RNA-seq in sphingolipid metabolism, CACYBP was identified as a potential therapeutic target in lung adenocarcinoma.

Lung adenocarcinoma (LUAD) is a heterogeneous disease with a dismal prognosis for advanced tumors. Immune-associated cells in the microenvironment substantially impact LUAD formation and progression, which has gained increased attention in recent decades. Sphingolipids have a profound impact on tumor formation and immune infiltration. However, few researchers have focused on the utilization of sphingolipid variables in the prediction of LUAD prognosis. The goal of this work was to identify the major sphingolipid-related genes (SRGs) in LUAD and develop a valid prognostic model based on SRGs. The most significant genes for sphingolipid metabolism (SM) were identified using the AUCell and WGCNA algorithms in conjunction with single-cell and bulk RNA-seq. LASSO and COX regression analysis was used to develop risk models, and patients were divided into high-and low-risk categories. External nine provided cohorts evaluated the correctness of the models. Differences in immune infiltration, mutation landscape, pathway enrichment, immune checkpoint expression, and immunotherapy were also further investigated in distinct subgroups. Finally, cell function assay was used to verify the role of CACYBP in LUAD cells. A total of 334 genes were selected as being most linked with SM activity for further investigation, and a risk model consisting of 11 genes was established using lasso and cox regression. According to the median risk value, patients were split into high- and low-risk groups, and the high-risk group had a worse prognosis. The low-risk group had more immune cell infiltration and higher expression of immune checkpoints, which illustrated that the low-risk group was more likely to benefit from immunotherapy. It was verified that CACYBP could increase the ability of LUAD cells to proliferate, invade, and migrate. The eleven-gene signature identified in this research may help physicians create individualized care plans for LUAD patients. CACYBP may be a new therapeutic target for patients with advanced LUAD.

Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using “Best Case/Worst Case”

Promoting Prognostic Understanding and Health Equity for Patients With Advanced Liver Disease: Using “Best Case/Worst Case”

Stroke Severity and Level of Dependence Against Risk of Falls in Stroke Patients

A stroke is a neurological disease caused by the blockage or rupture of blood vessels in the brain. Functional dysfunction due to stroke causes stroke patients to be very susceptible to falls. This research aimed to identify the association between the severity of stroke with the level of patient dependence on the risk of falls. This research was a quantitative observational design with a cross-sectional approach. The sample of this study was 66 hospitalized stroke patients who were recruited by quota sampling method. The National Institute of Health Stroke Scale (NIHSS) and Barthel Index are used to measure stroke severity and level of dependence. We assessed the risk of falls using the operational procedure from the hospital. Based on the Spearman rho test, it is found that there is a significant relationship between stroke severity and the level of risk of falls (p=0.000394). Similarly, a significant correlation was found between the level of patient dependence and the level of risk of falls (0.000016). Nurses need to set the nursing care plan for stroke patients who are at risk of falls to prevent further injuries and complications. Continuity of care and family support will help the patient's dependency, reduce the risk of falls, and promote quality of life.

Spectrum of Genetic Variants in the Dystrophin Gene: A Single Centre Retrospective Analysis of 750 Duchenne and Becker Patients from Southern Italy.

Dystrophinopathies are X-linked recessive muscle disorders caused by mutations in the dystrophin (DMD) gene that include deletions, duplications, and point mutations. Correct diagnosis is important for providing adequate patient care and family planning, especially at this time when mutation-specific therapies are available. We report a large single-centre study on the spectrum of DMD gene variants observed in 750 patients analyzed for suspected Duchenne (DMD) or Becker (BMD) muscular dystrophy, over the past 30 years, at the Cardiomyology and Medical Genetics of the University of Campania. We found 534 (71.21%) large deletions, 73 (9.73%) large duplications, and 112 (14.93%) point mutations, of which 44 (5.9%) were small ins/del causing frame-shifts, 57 (7.6%) nonsense mutations, 8 (1.1%) splice site and 3 (0.4%) intronic mutations, and 31 (4.13%) non mutations. Moreover, we report the prevalence of the different types of mutations in patients with DMD and BMD according to their decade of birth, from 1930 to 2020, and correlate the data to the different techniques used over the years. In the most recent decades, we observed an apparent increase in the prevalence of point mutations, probably due to the use of Next-Generation Sequencing (NGS). In conclusion, in southern Italy, deletions are the most frequent variation observed in DMD and BMD patients followed by point mutations and duplications, as elsewhere in the world. NGS was useful to identify point mutations in cases of strong suspicion of DMD/BMD negative on deletions/duplications analyses. In the era of personalized medicine and availability of new causative therapies, a collective effort is necessary to enable DMD and BMD patients to have timely genetic diagnoses and avoid late implementation of standard of care and late initiation of appropriate treatment.

Evaluation of Nutritional Interventions in the Care Plan for Cancer Patients: The NOA Project.

The NOA (Oncological Nutrition in Andalusia) project analyses the degree of integration and areas of improvement in implementing nutritional support in the care plans of cancer patients in Andalusia. The aim was to analyse nutritional interventions for better care of cancer patients and for the improvement of the management of malnutrition in cancer. A prospective evaluation of the implementation of two areas of improvement in nutrition was conducted in three hospitals. Data were collected from each hospital over a six-month period using an online platform. A standardised care plan was designed for hospitals in Andalusia, in which proposed improvements were devised and prioritised, selecting nutritional screening in oncology services and the participation of the Nutrition Support Team (NST) on the tumour boards, as well as the assessment of the patients presented at these sessions. Our results indicated an increase in the number of medical records with nutritional evaluation results six months later, regardless of the type of tumour or hospitalisation; and there was greater participation of the NST on the tumour boards, mainly for head and neck and oesophagogastric cases. Solutions for improvement have been pinpointed and implemented that have positively impacted the nutritional care plan in the course of oncological disease.

MANAGEMENT OF THE MAIN ULCER OF THE LOWER LIMBS BY THE STOMATHERAPIST NURSE

Lower limb ulcers constitute a serious worldwide social and collective health problem, affecting the user, arising spontaneously or accidentally, usually evolving into a chronic injury, accompanied by other preventable injuries. In Brazil, among lower limb ulcers, venous ulcers are the most prevalent, constituting 70% to 90% of ulcers, followed by 10% of arterial ulcers. The incapacity that generates the injury is worrying, since it leads to several changes and affects the quality of life. The general objective of this research is to point out the main etiologies of lower limb ulcers based on the literature. The specific objectives consist of presenting the characteristics of these injuries and the role of the stomal therapist nurse in managing them. The justification for this work is based on the increasing rates of complications of Diabetes Mellitus that generate ulcers and for better academic updating of health professionals in stomatherapy who also carry out continuing education with their patients and families. The research methodology was a bibliographic review and the databases consulted: SCIELO and BVS. Complete articles available online for free, from studies carried out with samples of patients of all ages, published between 2015 and 2020, written in Portuguese, Spanish and English, were included. Most of the studies presented pointed out the comorbidities: obesity, diabetes mellitus and arterial hypertension as conditions for the worsening of the patient’s condition and the interference in the healing process of the ulcer. Thus, the great challenge for nursing, especially for nurses, is the planning and implementation of care for patients with ulcers in the lower limbs.

The PEAK Aesthetic Consultation.

Aesthetic practitioners work diligently to perfect the depth of the needle injection, find the right products regimen, and create a perfect before and after visual. However, the true work of an aesthetic nurse lies in the conversations we have with our patients. Consultation may be overlooked by practitioners who are starting out and consultation is almost always the first item to be put aside by patients seeking aesthetic treatments. It is imperative for aestheticians to incorporate an effective consultation into the patient experience. The longevity of your career lives in the effectiveness of your patient consultation. This article explores the aesthetic consultation process and evaluates the importance of providing meaningful conversation that includes the patient while also managing patient expectations and creating a long-term care plan. Here, I share my own concept regarding aesthetic consultation. This concept allows me to consistently create a plan of care for my patients, while building trust and longevity in my practice. The PEAK Aesthetic Consultation process incorporates four elements: Prioritize the patient story; Education and expectations; Aesthetic treatment; and Kinetic plan.

Team approach for nonmedical opioid use

Team approach for nonmedical opioid use

Neurocritical Patients: Review of the Scope of Nursing Diagnoses and Care in the Intensive Care Unit.

To identify the diagnoses and nursing care for neurocritical patients in the intensive care unit. This is a scope review study, based on the Joanna Briggs Institute, led by the following guiding question: what are the diagnoses and nursing care for neurocritical patients in the intensive care unit? Data collection was carried out in February 2022 in a paired manner, in the following databases: EMBASE, MEDLINE, PubMed, and SCOPUS. For sample selection, the following search strategy was used: "Neurology" AND "Nursing Care" OR "Nursing Diagnosis" AND "Critical Care." Studies were independently selected, blinded by two reviewers. It was possible to identify 854 studies, which after analysis by title and abstract, only 27 articles passed the eligibility, of which 10 were part of this review. According to the analysis of the studies, it was found that nursing care, combined with a care plan for neurocritical patients, allows for better results, with a view to the quality of life and health promotion.

The Integration of Artificial Intelligence in Prosthodontic Practices

The integration of intelligence (AI), in practices is a significant advancement in dental care, providing transformative solutions across different aspects of clinical management. By utilizing AI treatment planning, prosthetic design and overall patient care can be greatly improved. This review explores the state of AI applications in prosthodontics examining studies and advancements that support its integration into clinical workflows. This review explores the state of AI applications in prosthodontics, focusing on its impact on care and clinical use. From speeding up diagnostics through automated image analysis to revolutionizing design and improving treatment planning, AI has shown potential. The proactive management of complications and enhanced patient communication further highlight AI's influence in prosthodontics. However, challenges related to data security and the need for training should be carefully considered. It is essential for dental professionals to collaborate with AI developers to ensure effective implementation. As technology advances, further research will refine the role of AI in prosthodontics, leading to better outcomes for both practitioners and patients.